jan, i was asking about why you said soy formula particularly, not just
supplementing - i'm with you, i would have had to fight the urge to do it
myself then and there  - i tell people to never use soy other than on an
"emergency:" basis (yes, there are people that even *I* can't convince to use
donor milk). maybe  we could have a discussion about what formula everyone
recommends in what situations?

 i was just discussing this today with a friend. if a baby has never had
anything else, and needs only a few feeds (all these are situations in which
the parents refuse to use donor milk), and they wish to use soy formula
(usually because of advertising-influenced doctor recommendations), i explain
to them the risks of soy but that i feel they are minimzed when used for only
a few feedings. i strongly recommend NOT using dairy-based formula if it has
not been given already. If someone needs a long-term formula to use and the
baby has already had dairy, the parents may choose to continue with it, and
hey, the damage is already done. i might also suggest using a hypoallergenic
like nutramigen, and to talk to their doctor. unfortunately, the docs all say
use either dairy or soy or a certain brand based exclusively on what rep has
the most power in their practice.

i intend to do more research about the hypoallergenic formulaes, but hey,
since i have only a pretend practice, i have all the time in the world to do
it. my friend is at a class today and mentioned that either lois arnold or
nikki lee were discussing the potential danger of using the predigested
hypoallergenics that do contain dairy proteins. the idea is, that if the gut
is already damaged from exposure to whatever, the reduced proteins in the
formula will have an easier time in being absorbed by the baby, and these
should only be introduced in a safe setting, as a challenge food, due to the
risk of anaphylactic shock. case studies were mentioned. i said "get back in
that class and get details," and, of course, we can quiz nikki lee when she
gets back on lactnet.

i personally think that if i  sent a doctor's report suggesting that a baby i
had seen needed to be given formula as a challenge food in the doctor's
office, they would send for the people with the butterfly nets to catch me.
but, professionally i think we should be very clear about what the risks are
and how to deal with them. but then again, in my area, ABM is the stock in
trade of LCs. also, i have seen the "discussing the risks of formula" talk
backfire in this sense: if a baby has already been given formula, which is
almost always true if there were any hint of a bf problem (and also often
when there wasn't) in the hospital, i sometimes see parents visibly think
"well, we've already ruined him, what difference does it make now?" it takes
a lot of explaining to show that its still worthwhile to work towards
exclusive bf.

carol brussel IBCLC

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